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Drugs for Bone and Joint Disorders

33. Drugs for Bone and Joint Disorders. Directory. Classroom Response System Lecture Note Presentation. Question 1. The patient taking calcitriol should be assessed for:. Question 1 Choices. Dysrhythmias Hypercalcemia Fluid overload Flulike symptoms. Question 1 Answer. Dysrhythmias

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Drugs for Bone and Joint Disorders

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  1. 33 Drugs for Bone and Joint Disorders

  2. Directory Classroom Response System Lecture Note Presentation

  3. Question 1 The patient taking calcitriol should be assessed for:

  4. Question 1 Choices Dysrhythmias Hypercalcemia Fluid overload Flulike symptoms

  5. Question 1 Answer Dysrhythmias Hypercalcemia Fluid overload Flulike symptoms

  6. Question 2 Which of the following statements demonstrates that the patient with gout needs additional instructions?

  7. Question 2 Choices “I will take my allopurinol as prescribed by my physician.” “I will stop having alcoholic beverages.” “I will avoid high purine foods.” “I will continue my aspirin therapy.”

  8. Question 2 Answer “I will take my allopurinol as prescribed by my physician.” “I will stop having alcoholic beverages.” “I will avoid high purine foods.” “I will continue my aspirin therapy.”

  9. Question 3 Because esophageal irritation can occur, this medication should not be used if the patient cannot remain in an upright position for 30 minutes after taking it.

  10. Question 3 Choices HT with estrogen Calcitonin Alendronate (Fosamax) Raloxifene (Evista)

  11. Question 3 Answer HT with estrogen Calcitonin Alendronate (Fosamax) Raloxifene (Evista)

  12. Question 4 This medication, when used intranasally, may cause irritation of the nasal mucosa.

  13. Question 4 Choices Calcitonin Vitamin D Calcium Raloxifene (Evista)

  14. Question 4 Answer Calcitonin Vitamin D Calcium Raloxifene (Evista)

  15. Learning Outcomes • Identify the different body systems contributing to body movement. • Discuss nonpharmacological therapies used to treat bone and joint disorders. • Identify important symptoms or disorders associated with an imbalance of calcium, vitamin D, parathyroid hormone, and calcitonin.

  16. Learning Outcomes • Describe the pharmacological management of disorders caused by calcium and vitamin D deficiency and disorders related directly to bones and joints. • Discuss drug treatments for hypocalcemia, osteomalacia, and rickets.

  17. Learning Outcomes • Identify important disorders characterized by weak, fragile bones and abnormal joints. • For each of the drug classes, know representative drugs, and explain their mechanisms of action, primary actions, and important adverse effects.

  18. Core Concept 33.1 Adequate levels of calcium, vitamin D, parathyroid hormone, and calcitonin are necessary for normal body processes.

  19. Figure 33.1 (a) Parathyroid hormone (PTH); (b) calcitonin action

  20. Figure 33.1 (continued) (a) Parathyroid hormone (PTH); (b) calcitonin action

  21. Figure 33.2 Pathway for vitamin D activation

  22. Core Concept 33.2 Hypocalcemia is a serious condition that requires immediate therapy.

  23. Calcium Disorders • Treatments • Calcium supplements, vitamin D supplements, bisphosphonates, and/or several misc. • Conditions of calcium and vitamin D metabolism • Hypocalcemia, osteomalacia, osteoporosis, and Paget’s disease.

  24. Calcium Disorders • Causes • Hyposecretion of PTH • When the thyroid and parathyroid glands are surgically removed. • Digestive-related malabsorption disorders • Vitamin D deficiencies

  25. Core Concept 33.3 Treatment for osteomalacia consists of calcium and vitamin D supplements.

  26. Osteomalacia • Signs and symptoms • Hypocalcemia, muscle weakness, muscle spasms, and diffuse bone pain, especially in the hip area. pain in the arms, legs, and spinal column. • Rickets in children include bowlegs and a pigeon breast. Children may also develop a slight fever and become restless at night.

  27. Osteomalacia • Treatment • In extreme cases, surgical correction of disfigured limbs may be required. • Drug therapy for children and adults consists of calcium and vitamin D supplements

  28. Concept Review 33.1 • Identify the major drug therapies used for hypocalcemia, osteomalacia, and rickets

  29. Core Concept 33.4 Treatment for osteoporosis includes calcitonin estrogen-receptor modulator drugs, and bisphosphonates.

  30. Risk Factors For Osteoporosis: • Postmenopause • High alcohol or caffeine consumption • Anorexia nervosa • Tobacco use • Physical inactivity • Testosterone deficiency, particularly in elderly men

  31. Risk Factors For Osteoporosis • Lack of adequate vitamin D or calcium in the diet • Drugs such as corticosteroids, some anticonvulsants, and immunosuppressants that lower calcium levels in the bloodstream

  32. Figure 33.3 Calcium metabolism in osteoporosis: (a) normal calcium intake; (b) low calcium intake

  33. Drug Therapies For Osteoporosis • Calcium • Vitamin D Therapy • Hormone Therapy with Estrogen • Estrogen-receptor modulators • Calcitonin • Statins • Slow-release sodium fluoride • Bisphosphonates.

  34. Table 33.2 (continued) Bone Resorption Inhibitors and Selected Drugs

  35. Concept Review 33.2 • What are the major drug therapies used for the treatment of osteoporosis and related bone disorders?

  36. Core Concept 33.5 Treatment for Paget’s disease includes bisphosphonates and calcitonin.

  37. Paget’s Disease • Cause of Paget’s • Blood levels of the enzyme alkaline phosphatase & calcium are elevated because of the extensive bone turnover.

  38. Paget’s Disease • Treatment • Bisphosphonates • Therapy is usually cyclic: bisphosphonates are administered until serum alkaline phosphatase levels return to normal; then a drug-free period of several months follows • Patients should receive adequate, daily dietary intake of calcium and vitamin D. Sufficient exposure to sunlight is also important.

  39. Concept Review 33.3 • Identify two important disorders characterized by weak and fragile bones. What are the major drug therapies used in their treatments?

  40. Core Concept 33.6 Analgesics and anti-inflammatory drugs are important components of pharmacotherapy for osteoarthritis.

  41. Core Concept 33.7 Glucocorticoids, immunosuppressants, and disease-modifying drugs are additional therapies used to treat rheumatoid arthritis.

  42. RA Treatments • Analgesics and anti-inflammatories • Glucocorticoids • Disease-modifying antirheumatic drugs (DMARDs): hydroxychloroquine (Plaquenil), gold salts, sulfasalazine (Azulfidine), D-penicillamine (Cuprimine)

  43. RA Treatments • Immunosuppressants: methotrexate (Rheumatrex), leflunomide (Arava), azathioprine (Imuran), cyclosporine (Neoral), cyclophosphamide (Cytoxan) • Biologic agents; tumor necrosis factor blockers and interleukin-1 blockers: etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), anakinra (Kineret)

  44. Table 33.3 (continued) Disease-Modifying and Related Drugs for Rheumatoid Arthritis

  45. Concept Review 33.4 • Identify the major types of arthritis. What are the general differences between these disorders?

  46. Core Concept 33.8 Drug therapy for gout requires agents that inhibit uric acid buildup.

  47. Gout • Accumulation of uric acid crystals that occurs when excretion of uric acid by the kidneys is reduced • Primary gout: genetic errors in uric acid metabolism, is most commonly observed in Pacific Islanders.

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